Asked by: Baroness Gardner of Parkes (Conservative - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty's Government, further to the Written Answer by Baroness Blackwood of North Oxford on 6 August 2019 (HL17643), how much new funding they provided in 2019 for new measures to prevent the transmission of carbapenem-resistant Enterobacteriaceae.
Answered by Baroness Blackwood of North Oxford
Public Health England has not received any new funding for the prevention of transmission of the carbapenem-resistant Enterobacteriaceae.
Asked by: Baroness Gardner of Parkes (Conservative - Life peer)
Question to the Department for Business, Energy and Industrial Strategy:
To ask Her Majesty's Government, further to the Written Answer by Lord Henley on 11 April 2019 (HL15230), how many agencies employing careworkers are paying the costs of such workers for their travel between clients; and what steps they take to ensure that care agencies pay staff appropriate renumeration for any time spent travelling between appointments.
Answered by Lord Duncan of Springbank
The law is clear that for care workers, and other workers, time spent travelling between assignments counts as time worked for National Minimum Wage and National Living Wage (NMW) purposes. Furthermore, the Government issued statutory guidance supporting the implementation of the Care Act which specifies; “Remuneration must be at least sufficient to comply with the NMW legislation for hourly pay or equivalent salary. This will include appropriate remuneration for any time spent travelling between appointments.”
The Government has more than doubled the NMW compliance and enforcement budget to £27.4 million for 2019/20, up from £13.2 million in 2015/16. HMRC utilise those resources to follow up on every worker complaint received and to undertake proactive investigations. Last year (2018/19), HMRC identified over £6 million in minimum wage arrears within the Human Health and Social Work sector, owed to over 27,000 workers. This includes, but is not limited to, arrears relating to travel time.
Workers can call the ACAS helpline for free, confidential advice about their rights and entitlements. If they want to make a complaint through HMRC, they can do so in complete confidence, either via ACAS or using the online complaints form on GOV.UK. HMRC will protect their anonymity throughout the investigation.
Asked by: Baroness Gardner of Parkes (Conservative - Life peer)
Question to the Department for Levelling Up, Housing & Communities:
To ask Her Majesty's Government what assessment they have made of (1) the impact of the Deregulation Act 2015 on short-term lettings, and (2) the proposal by the Mayor of London in April 2019 for the introduction of a registration system for those renting property for less than 90 days in a calendar year in London; and what plans they have, if any, to introduce such a system.
Answered by Viscount Younger of Leckie - Parliamentary Under-Secretary (Department for Work and Pensions)
The Deregulation Act 2015 limits short-term lettings in London to 90 days per property per calendar year. We have not made any specific assessment of its impact on short-term lettings. As to the proposal by the Mayor of London, the Government has no current plans to introduce such a register. However, we are aware of the work by the Short-Term Accommodation Association as well as platforms such as Airbnb, HomeAway and TripAdvisor to put in place their own procedures to avoid breach of the 90-day limit which we note with interest.
Asked by: Baroness Gardner of Parkes (Conservative - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty's Government what steps they intend to take in respone to the shortage of National Health Service dentists.
Answered by Baroness Blackwood of North Oxford
The latest headcount data published by NHS Digital show that the total number of dentists actively delivering National Health Service services increased from 24,308 to 24,545 during the period 2017/18 to 2018/19.
Both NHS England and Health Education England (HEE) have initiatives in place to tackle recruitment and retention issues. HEE’s current programme Advancing Dental Care is exploring the opportunities for flexible dental training pathways that can better serve patients as well as improving dental workforce retention. NHS England is introducing ‘flexible commissioning’, which allows local NHS commissioners to commission a wider range of services from dental practices which is expected to make NHS dentistry more attractive to newly qualified dentists.
These initiatives sit alongside the Department’s and NHS England’s work to reform the current NHS dental contract to support dentists to deliver preventatively focussed care. The patient pathway in the new model makes greater use of the whole dental team including nurses and therapists which moves away from needing dentists to complete every course of treatment.
The interim NHS People Plan, published in June 2019, sets out plans for the future dental workforce. This commits to creating a capable and motivated multidisciplinary dental workforce, of a sufficient size, to meet population health needs.
Asked by: Baroness Gardner of Parkes (Conservative - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty's Government, further to the Written Answer by Baroness Blackwood of North Oxford on 9 July (HL16592), what is their view of the proportion of each of the resulting illness, deaths and costs that could be prevented by new efforts to prevent transmission; and what are the costs of new measures introduced in 2019 to prevent transmission of carbapenem-resistant Enterobacteriaceae.
Answered by Baroness Blackwood of North Oxford
Public Health England (PHE) has prioritised collecting the necessary data across the National Health Service to enable estimation and monitoring of the proportion of cases, deaths and costs attributable to carbapenemase-resistant Enterobacteriaceae.
In May 2015 PHE implemented an enhanced surveillance system of all carbapenemase-producing Gram negative bacteria, which was modified in 2019 to maximise efficiency. The health burden of cases, estimated from these data, will be published in the English Surveillance Programme for Antimicrobial Utilisation Report in November 2019.
The few published reports of outbreaks have estimated costs of at least £1 million, and up to £5 million, all indicating multi-model control measures are required, as outlined in the PHE toolkit for prevention and control of carbapenemase-producing Enterobacteriaceae which is currently being updated.
Using national surveillance and patient administration data to develop mathematical models, work is ongoing to estimate the reduction in levels of illness and death when specified detection and control measures are applied by 2020. Developed models will enable associated costs incurred to be estimated and the cost-effectiveness of control measures to be established by 2021.
Asked by: Baroness Gardner of Parkes (Conservative - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty's Government, further to the Written Answer by Baroness Blackwood of North Oxford on 4 June (HL15832), what assessment they have made of (1) the future costs to the NHS as a result of the spread of carbapenem-resistant Enterobacteriaceae, (2) the costs of new measures introduced in 2019 specifically to prevent the transmission of such Enterobacteriaceae, and (3) the views of infection control nurses on investment to prevent the transmission of such Enterobacteriaceae.
Answered by Baroness Blackwood of North Oxford
Public Health England (PHE) has predicted future spread and the health and cost impact to the National Health Service of the Enterobacteriaceae Escherichia coli and a national outbreak of a highly-resistant organism, reflecting carbapenem-resistant Enterobacteriaceae. The models used in this assessment are published in the paper A Risk Assessment of Antibiotic Pan-Drug-Resistance in the UK: Bayesian Analysis of an Expert Elicitation Study. A copy of the paper is attached.
Such predictions are highly uncertain. There remain unknowns regarding transmission, efficacy of interventions and the additional hospital stay for infected patients (constituting a large part of the cost to the NHS).
PHE has worked with NHS colleagues, estimating the cost of controlling a carbapenemase-producing Enterobacteriaceae (CPE) outbreak in five London hospitals to be over £1 million. Monitoring costs alongside implementation of PHE’s upcoming update of the CPE toolkit for health and social care is an important component of enabling cost-effectiveness evaluation.
Staff interviewed about the challenges of implementing the existing CPE toolkit highlighted maintaining awareness and training as key challenges, alongside infection prevention resourcing. An analysis of the responses was published in the paper An evaluation of a toolkit for the early detection, management, and control of carbapenemase-producing Enterobacteriaceae: a survey of acute hospital trusts in England. A copy is attached.
Asked by: Baroness Gardner of Parkes (Conservative - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty's Government, further to the Written Answer by Baroness Blackwood of North Oxford on 14 May (HL15384), what assessment they have made of the number of people, with or without resistant blood stream infections, who have Carbapenem resistant E. coli-like bacteria present in their bodies; and what (1) proposed, and (2) current, initiatives there are to control the transmission of such bacteria.
Answered by Baroness Blackwood of North Oxford
The 2018 English surveillance programme for antimicrobial utilisation and resistance report contains information on carbapenem-resistant Escherichia coli (E. coli) causing bloodstream infections in England. In 2017 there were 18 cases. The number of people with other infections and carriage of E. coli resistant to carbapenems is harder to ascertain as surveillance is not as uniform.
Public Health England (PHE) publishes guidance on the prevention and control of carbapenemase-producing Enterobacteriaceae (including E. coli); guidance is available for both acute and non-acute settings, copies of the Toolkit for managing carbapenemase-producing Enterobacteriaceae in non-acute and community settings and Acute trust toolkit for the early detection, management and control of carbapenemase-producing Enterobacteriaceae are attached. PHE is supporting actions outlined in the United Kingdom’s Tackling Antimicrobial Resistance National Action Plan that aim to prevent and control the transmission of carbapenem-resistant bacteria, which includes reducing the number of specific drug-resistant infections in people by 10% by 2025; reducing UK antimicrobial use in humans by 15% by 2024; and adding carbapenem-resistant Gram-negative infections to the list of notifiable diseases in existing laboratory reporting systems.
Asked by: Baroness Gardner of Parkes (Conservative - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty's Government what assessment they have made of the effectiveness of their 2013–18 antimicrobial resistance strategy at addressing the problem of multi-resistant E. coli-like bacteria; what assessment they have made of recent trends in the number of multi-resistant E. coli-like bacteria in the UK; and what factors inform their view of the balance between efforts to reduce transmission and efforts to reduce the use of antibiotics.
Answered by Baroness Blackwood of North Oxford
While we can count many successes from our 2013-18 Antimicrobial Resistance (AMR) Strategy, resistance has continued to increase. In the United Kingdom we have seen a 35% increase in resistant blood stream infections in humans from 2013-17.
The number of bloodstream infections (BSIs) is increasing each year. Although the proportion of antibiotic resistant BSIs remain stable year to year, the burden on resistance increases. This is mostly due to increasing prevalence of E.coli bloodstream infections.
Estimates of the multi-resistant cases can be made, however not all the bacteria are tested against the same antibiotics, so a definitive number of cases cannot be given. The Public Health England Fingertips tool also has an indicator showing the rolling quarterly average proportion of E. coli blood specimens non-susceptible to at least three of the key antimicrobials (gentamicin, ciprofloxacin, piperacillin/tazobactam, 3rd-generation cephalosporins or carbapenems). For England this is 5.5% with little fluctuation over time.
This is exactly why the UK’s five-year national action plan for AMR, published alongside the UK 20-year vision for AMR on 24 January 2019, includes a strengthened focus on infection prevention and control, renewing our commitment to halve levels of healthcare associated Gram-negative blood stream infections (mostly E.coli) by 2023-24. The plan also sets a world-first target to reduce the actual numbers of resistant infections, with the aim to reduce them by 10% by 2025.
We are working with the devolved health administrations to develop consistent methodologies for reporting the incidence and mortality of key antibiotic resistant infections and antimicrobial use to allow us to report progress on the ambitions of the AMR national action plan.
As reductions in inappropriate prescribing also reduces the risk of promoting the growth of antibiotic-resistant bacteria, interventions to reduce antibiotic prescribing or transmission of the bacteria are complementary.
Asked by: Baroness Gardner of Parkes (Conservative - Life peer)
Question to the Department for Business, Energy and Industrial Strategy:
To ask Her Majesty's Government what steps they are taking to check whether agencies employing careworkers are paying the costs of such workers for their travel between clients.
Answered by Lord Henley
Time spent travelling from one client to another counts as time worked for minimum wage purposes, and the Government is clear that everyone entitled to the National Minimum and Living Wage (NMW) should receive it. Since 2015, the Government has almost doubled the budget for enforcing the NMW to £26.3 million, a record high.
Anyone who feels they are not receiving the NMW should contact the Advisory, Conciliation and Arbitration Service (Acas), who provide free, impartial information and advice on all aspects of workplace relations and employment law. Where appropriate, Acas can pass on complaints to HMRC for enforcement; HMRC follow up on all complaints received from workers about possible NMW underpayment.
Asked by: Baroness Gardner of Parkes (Conservative - Life peer)
Question to the Department for Levelling Up, Housing & Communities:
To ask Her Majesty's Government, further to the reply by Lord Bourne of Aberystwyth on 26 February (HL Deb, col 88), what assessment they have made (1) of reports in the media, as broadcast on BBC1 on 25 February, about companies offering advice to circumvent the 90-day limit for short-term lettings, and (2) of the existing regulatory framework for those who offer such lettings; and what plans they have to ensure that the 90-day limit is enforced.
Answered by Lord Bourne of Aberystwyth
The Government has been clear that it is illegal to let a property out on a short-term basis in London for more than 90 days in a calendar year without appropriate planning permission. Therefore, the Government condemns any actions taken to encourage landlords to break the law.
We are encouraging the Short Term Accommodation Association (STAA) to drive up standards and promote best practice, and to work with local authorities to support their enforcement and monitoring functions. The STAA has developed a package of measures to help hosts, guests and building managers and owners understand their legal responsibilities, which will help to tackle awareness and enforcement of the 90 night rule.
Responsibility for enforcing the 90 night rule in London lies with local authorities, as it does for any breaches of planning control, and householders who breach the rules face potentially significant fines.